Hormones and Burnout, Part 2: The Mind
Presented by Megan Patterson
Most BCBAs I talk to don't need more health tips. You know about protein and water and sleep, and you could write the behavior plan for it in your head. What gets in the way is the moment itself. Lunch disappears, you get home with nothing left, and you hear yourself think: I'm so tired. I'll do it tomorrow. I already tried this and it didn't work. Each time the plan falls apart, it gets a little harder to believe the next try will go differently. I said those exact things for years. I lost 70 pounds working with a nutrition and fitness coach, and the hardest part still wasn't knowing what to do. It was doing it on the days I had nothing left. Acceptance and Commitment Therapy (ACT) is what changed that for me, and this course is the five-week ACT program I built for women who put themselves last, rebuilt for behavior analysts with the research behind it. There are five modules. Inner barriers covers thoughts, rules, and defusion, so a rule like "if I miss one workout, the whole week is ruined" has less pull on what you do next. Outer barriers covers your environment, sleep, nutrition, stress, and the social pressure at work and at home. Then values, committed action with if-then plans and a smallest version for hard days, and a long-term plan for the week you get off track, because that week is coming and it doesn't have to undo the rest. Fourteen short guided practices let you use each skill while you learn it. Take it straight through, or finish a module, practice for a week, and come back. You don't need Part 1, and if you took it, there's a short bridge at the start. You'll get a participant workbook, a one-page plan, and a BCBA freezer dinner guide.
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About this CEU
You already know you should eat lunch, drink water, and work out. So you made a plan. You prepped your lunch, filled your water bottle, and told yourself you'd work out after work. Then a session ran over, your lunch sat in your bag untouched, and by 6 pm all you wanted was the couch and one thought: I already blew it, so why bother. This course uses ACT to help you follow through on your own health habits when the day doesn't go as planned and your thoughts get loud.
Abstract
Most BCBAs I talk to don't need more health tips. You know about protein and water and sleep, and you could write the behavior plan for it in your head. What gets in the way is the moment itself. Lunch disappears, you get home with nothing left, and you hear yourself think: I'm so tired. I'll do it tomorrow. I already tried this and it didn't work. Each time the plan falls apart, it gets a little harder to believe the next try will go differently. I said those exact things for years. I lost 70 pounds working with a nutrition and fitness coach, and the hardest part still wasn't knowing what to do. It was doing it on the days I had nothing left. Acceptance and Commitment Therapy (ACT) is what changed that for me, and this course is the five-week ACT program I built for women who put themselves last, rebuilt for behavior analysts with the research behind it. There are five modules. Inner barriers covers thoughts, rules, and defusion, so a rule like "if I miss one workout, the whole week is ruined" has less pull on what you do next. Outer barriers covers your environment, sleep, nutrition, stress, and the social pressure at work and at home. Then values, committed action with if-then plans and a smallest version for hard days, and a long-term plan for the week you get off track, because that week is coming and it doesn't have to undo the rest. Fourteen short guided practices let you use each skill while you learn it. Take it straight through, or finish a module, practice for a week, and come back. You don't need Part 1, and if you took it, there's a short bridge at the start. You'll get a participant workbook, a one-page plan, and a BCBA freezer dinner guide.
Credits
2.5 CEUs · 129 min
From the talk
What was covered
ACT tools for BCBAs who know what to do and still skip lunch: unhooking from thoughts, environment setups, values, and if-then plans.
- Pick one small health behavior. Tie it to a value so the payoff feels real today, not months from now.
- Write your top blocking thought word for word, as clearly as you would define any target behavior. Then practice one unhooking tool on it daily.
- Change one thing in your home or work setup this week instead of trying to find more discipline.
- Write an if-then plan for the barrier you already know is coming. The obstacle becomes the cue for your backup action.
- Decide the smallest version of your behavior that still counts on your hardest day, and use it instead of skipping.
- Treat a missed day as data, not a verdict, and pick up exactly where you left off.
Why Knowing the Plan Is Not the Problem
Most BCBAs do not need another health tip. You know about protein, water, and sleep. You could write the behavior plan in your head. What breaks down is the moment itself. Lunch stays in your bag. You get home with nothing left. Then a thought shows up: I'll do it tomorrow.
Megan Patterson became a BCBA in the fall of 2017. By early 2018 she saw changes in her body and her stress. Between 2018 and 2021 she gained close to 70 pounds. She had depression and anxiety. Her PMS was bad enough that she called out of work a couple of times a month. She tried plan after plan. Each one stopped after a few weeks.
She hired a nutrition and fitness coach and finally had real direction. She learned to eat enough first. Over the next couple of years she lost the 70 pounds and kept them off. But her coach had no behavior change background. And knowing what to do was never the hard part. The hard part was a packed Wednesday with a report due.
So she went back to the research and found Acceptance and Commitment Therapy, or ACT (a behavior-based approach to thoughts). She built a five week group course around it for women who always put themselves last. This CEU is that course, rebuilt for behavior analysts. One scope note from the talk. Patterson is a BCBA and a certified nutrition and fitness coach. She is not a licensed therapist or a registered dietitian. This course teaches ACT for your own self-management. It is not therapy or treatment.
Knowing exactly what to do and doing it are two different things.
From the talk — Megan Patterson
ACT Terms That Map Onto Behavior Analysis
ACT has its own words. A lot of them map onto ours. Start with private events (thoughts only you can see). Skinner was clear that these are behavior too. They follow the same principles as anything we can watch. A thought is something you do.
Next is rule-governed behavior (behavior guided by stated rules). A rule is a verbal statement that describes a contingency. If I don't go to the gym for an hour, it doesn't count. Rules are useful. They let us respond to results we have never met directly. They can also make behavior less sensitive to what is really happening. The rule says one thing. The real contingencies say another. We follow the rule anyway.
Psychological flexibility (noticing thoughts and still acting well) is the core of ACT. Hayes and colleagues describe six processes that build it. They are acceptance, defusion, present moment awareness, self as context, values, and committed action. Defusion means stepping back from a thought. Present moment awareness means staying with what is happening right now. Self as context means seeing yourself as separate from your thoughts. Committed action means acting on what matters even when it is hard. Experiential avoidance (dodging your own uncomfortable feelings) works against it. Fusion means you are inside a thought, and defusion creates space from it. Patterson mostly calls that unhooking.
This matters for burnout. In one of the early ACT workplace studies, Hayes and colleagues gave substance abuse counselors a one day ACT training. The ACT group reported less burnout at follow-up than the control group. Other studies in human service and healthcare settings found similar patterns. ACT also grew out of our science. Hayes and colleagues built it on relational frame theory (how we learn to relate words). One limit: using these procedures with clients or supervisees takes more training and supervised experience, inside your scope of competence.
It's an extension of it into private events.
From the talk — Megan Patterson
Four Inner Barriers to Your Own Health Behavior
Barrier one is avoiding discomfort. It can be physical, like sore muscles, being out of breath, or feeling awkward at the gym. It can also be emotional, like worrying what people think or fearing you will fail before you start. So we skip. We don't open the food log. We don't step on the scale. The relief is negative reinforcement (relief that strengthens the behavior), so skipping grows. Patterson once went a whole year without weighing herself. Not looking felt better each week, and looking got harder.
Barrier two is being stuck in a story. I always quit by Wednesday. I'm not someone who sticks with things. ACT calls this fusion with the conceptualized self (being fused with your own story). The story makes the future look just like the past.
Barrier three is holding on too tight. If I don't sweat, the workout didn't count. Barrier four is self-imposed pressure. Here is the one Patterson hears often from BCBAs: I have a master's in behavior change. I should be able to fix my own habits. Following a rule mainly to look right relates to pliance (rule following to please others).
These barriers show up as sentences. The talk lists eight common patterns. They include all or nothing thinking, fear of failure, comparison, and the time and energy one. I don't have time feels like a fact about your calendar. It is a thought. A thought like I already ruined today can work as a motivating operation (it shifts what feels worth doing). It can act as a rule at the same time. So write the sentence word for word. It is the same reason we write operational definitions (clear, measurable descriptions of behavior).
One off-plan meal changes almost nothing about your health.
From the talk — Megan Patterson
Six Ways to Unhook From a Sticky Thought
Being hooked means the thought picks your next move. I'm too tired to work out stops being a thought. It becomes an instruction, and you follow it without noticing a choice. Unhooking is not arguing with the thought. It is not swapping it for a nicer one.
ACT asks about workability instead of truth. Not: is this thought true? Instead: if I let this thought guide me, does it move me toward the life I want? In our terms, the thought gets less stimulus control (less pull as a cue) over what happens next.
The talk gives six tools. Label it: I'm having the thought that I hate cooking. Thank your mind. Sing the thought to Happy Birthday. Say it in a cartoon voice. Notice where you feel it in your body. Or change but to and. I want to move more, but I'm exhausted is a dead end. I want to move more, and I'm exhausted leaves room for a ten minute walk.
There is research behind the silly tools. In a study by Masuda and colleagues, people repeated a negative word about themselves out loud, fast, for about 30 seconds. Afterward, the word felt less believable and less upsetting than it did for people who used distraction. Practice your tool one to three times a day, before you need it under pressure. Jess, a made-up BCBA the talk follows, used but to and. From that bit of space she saw she could drink half a bottle while writing notes.
It's changing your relationship with the thought, so it's something you notice instead of something that runs the show.
From the talk — Megan Patterson
Antecedent Strategies for Your Kitchen, Your Desk, and Your Team
Behavior follows the path of least response effort (how hard it is to do). If your walking shoes are buried in a closet, they do not exist. So stop pushing for more discipline. Use antecedent intervention (setting things up in advance) on yourself. In a large meta-analysis of healthy eating nudges, changes to convenience moved behavior more than giving people information did.
At home, pick a few small changes. Set up a breakfast station in one spot. Write two or three go-to meals on the fridge. Put your shoes where you will trip over them. Put a protein option right next to the snack you already reach for. Stock a few single serve freezer meals for the hard nights. Leave a sticky note that asks one question: what do I actually need right now?
At work, block your lunch on the calendar like an appointment. Block 15 minutes if that is all you control. Keep food in your bag or your desk drawer. Try a water bottle in each place you sit. A standing desk or walking pad takes friction out of moving. Some employers will buy one as a wellness benefit.
People are the third outer barrier. In a review of social modeling studies, people ate more when those around them ate more. They also ate less when the people around them ate less, even without noticing it. So pick your script before the moment. I already brought my lunch, and I'd love to sit with you all. Jess started sitting down for 15 minutes. The second week, one RBT joined her.
Design it for the days motivation doesn't show up.
From the talk — Megan Patterson
Sleep, Food, and Stress as Setting Events
Sleep, food, and stress work like setting events (conditions that shift behavior's odds). They do not cause a skipped workout by themselves. They change how likely it is. Pick one of the three to work on. Pick the one with the most payoff for the least effort.
Short sleep is linked to higher ghrelin (the hunger signal) and lower leptin (the fullness signal). In a study by Spiegel and colleagues, two nights of short sleep raised ghrelin and lowered leptin in healthy young men. Hunger went up too, especially for carb-heavy food. A meta-analysis found people ate about 385 more calories the day after partial sleep loss. Imaging work shows more reward activity to high calorie food when people are tired. So take a week of baseline. Then move bedtime 10 minutes earlier for two weeks.
For food, the guidelines are simple. Eat within an hour or two of waking, with some protein. Then eat every three to four hours, with protein, fat, and carbs together. A review by Leidy and colleagues found higher protein meals generally improve fullness. Add, don't subtract: have the jerky first, then your chips. And try water before the three o'clock coffee.
For stress, calm the body first. Slow breathing with a long exhale works fast. So does tensing and releasing one muscle group at a time. Then swap the autopilot habit for one that gives the same relief. In our terms, that is a functionally equivalent replacement behavior (same relief, different action). Tea instead of scrolling. A two to five minute stretch. When the urge hits, wait 30 seconds, then decide.
We would never ask a client to keep doing a new behavior with zero reinforcement.
From the talk — Megan Patterson
Values, Toward Moves, and Choice Points
A goal is something you check off. A value is a direction you never finish. Walk 5,000 steps four days a week is a goal. Being a kind person is a value. The goal is a destination. The value is the compass.
In ACT, values work as verbally constructed reinforcers (words that make small acts matter). That is useful for us. The natural results of health behavior are delayed, small, and add up slowly. They compete poorly with the couch or the cookie. Tying water to presence with your afternoon clients changes what that glass of water means right now.
The talk walks through a short exercise. Finish this sentence: I'm becoming someone who. Then pick one or two words, like energy, presence, or self-respect. Then ask why it matters, five times. Jess started with energy. By the last why, her value became something like presence with her clients.
Then name two toward moves and two away moves for one hard moment. Neither one is good or bad. They are directions. The fork itself is a choice point. Research on stress suggests that under pressure people shift from planned choices to habits. So use the pause. One slow breath, then two questions. What do I need right now? Is this move taking me toward my value or away from it?
It's a pattern, not a spotless record.
From the talk — Megan Patterson
Committed Action, If-Then Plans, and the Week You Get Off Track
Russ Harris describes committed action as effective action guided by your values. That is the part of ACT that looks most like our day job. Committed actions are values-driven, flexible, and something you can keep doing. If your baseline is 2,000 steps, your first goal is not 10,000. It is a 15 minute walk most days.
Then build the hard day into the plan. Use an if-then plan. If I have back-to-back sessions and no lunch, then I'll eat a protein bar between clients. The obstacle becomes the cue for the backup. Researchers call these implementation intentions (if-then plans made in advance). A meta-analysis of 94 studies found a medium to large effect on reaching goals. An if-then plan is a rule you write on purpose, and it bends.
Add an anchor and a smallest version. Anchor the behavior to something that already happens daily. When I sit down to write notes, I refill my bottle. Then decide what still counts on your worst day. Walk 20 minutes becomes walk to the mailbox. In a study by Lally and colleagues, a new daily behavior took a median of 66 days to feel automatic. The range ran from 18 days to 254. Missing a day here and there did not derail it.
Last, build a weekly rhythm. Check your barriers at the start of the week. Catch your top thought midweek. Come back to your value when things get messy. Then take five minutes to review your data. Adjust the plan, not the learner. Relapse researchers separate a lapse, one slip, from a relapse, a full return to the old pattern. What turns one into the other is often the thought that you already blew it. So notice it, unhook, and take the smallest version of your next toward move.
On the hardest days, keeping the behavior alive matters more than hitting the full target.
From the talk — Megan Patterson
Common questions
Do I need to take Part 1 before this course?▾
No. This course stands on its own. There is a short bridge at the start for people who took Part 1. If you did take it, bring the one health behavior you picked. If you did not, pick one small behavior now, like drinking more water or walking after work.
Can I use these ACT procedures with my clients or supervisees?▾
Not based on this course alone. The talk teaches ACT for your own self-management, and the speaker is clear about that. Using these procedures with clients or supervisees takes more training and supervised experience. It also has to fit your scope of competence, as described by the BACB (Behavior Analyst Certification Board) ethics code.
What are the four inner barriers covered in Module 1?▾
Avoiding discomfort, being stuck in a story, holding on too tight, and self-imposed pressure. Each one is framed in both ACT and behavior-analytic terms. For example, avoiding discomfort is experiential avoidance, and the relief that follows works as negative reinforcement.
What materials come with the course?▾
A Part 2 participant workbook, a one page plan to keep, and a research reference list. The list includes every study the speaker mentions. Participants also get a BCBA freezer dinner guide. Every list, chart, and exercise in the talk is written out in those materials.
Can I spread the course over five weeks instead of watching it straight through?▾
Yes. You can go start to finish. Or you can stop at the end of a module and practice for a week before the next one. The second way is how the speaker first taught the material, as a five week group. Either way earns the same credit.
Is this course therapy or a nutrition plan?▾
No. The speaker states she is a BCBA and a certified nutrition and fitness coach. She is not a licensed mental health therapist or a registered dietitian. The course is not diagnosis or treatment. She asks you to reach out to a licensed mental health professional if you are struggling. She also asks you to talk with your physician before you change your diet, exercise, or health care.
About the speaker
Megan Patterson is a board certified behavior analyst and a certified nutrition and fitness coach. She became a BCBA in the fall of 2017. Over the next three years she gained close to 70 pounds. She later lost that weight and kept it off while working with a nutrition and fitness coach. She first taught this material as a five week group for women who put themselves last. She notes she is not a licensed mental health therapist or a registered dietitian.
This summary was generated from the recording’s transcript. Quotes are taken word for word from the talk.
What you'll learn
- 1Describe four inner barriers to health behavior using ACT and behavior-analytic terms. Apply at least three defusion strategies to reduce the influence of unhelpful thoughts and rules on health behavior. Identify environmental, biological, and social barriers to health behavior and select antecedent strategies to address them. Distinguish values from goals and identify personal values related to health. Use toward and away moves and choice points to evaluate health behaviors as they happen. Develop committed actions with if-then plans and a weekly review routine to maintain health behaviors.
Course materials
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